目的:总结并对比肉芽肿性小叶性乳腺炎(granulomatous lobular mastitis,GLM)与乳腺浸润性小叶癌(infiltrating lobular carcinoma of the breast,ILC)的超声声像图特征,以期提高对两者的鉴别诊断.方法:回顾并分析北京协和医院28个GLM病灶及58个ILC病灶超声图像,对比分析两组患者的临床资料及超声声像图表现,包括病灶形态、纵横比、边界、周边晕环、内部导管扩张、液化区、钙化等.结果:两组病灶在发病年龄、红肿热痛等临床表现,以及超声显示的形态、内部导管扩张、液化区及钙化等方面差异均有统计学意义(P<0.05).结论:GLM相较于ILC病灶内更易出现液化区、导管扩张、血流丰富等表现,综合分析超声与临床表现有助于提高对两者的鉴别诊断.

目的 观察320排容积CT全脑灌注成像(CTP)在缺血性脑血管病变(ICVD)中的应用价值.方法 选取2017年1月—2018年12月72例拟诊ICVD病人,入院24 h内均行常规CT检查、320排容积CTP检查,获得脑血流量(CBF)、脑血容量(CBV)、平均通过时间(MTT)、达峰时间(TTP)等灌注参数及动态CT血管成像图(4D-CTA),分析常规CT平扫、全脑CTP、4D-CTA结果.结果 72例病人CT平扫中43例未见明显异常,29例发现37个脑缺血病灶,全脑CTP灌注异常51例,共发现76个病灶;异常灌注区灌注参数CBF值低于健侧镜像区(P<0.05),MTT值、TTP值均高于健侧镜像区(P<0.05);4D-CTA图像提示59例存在不同程度血管狭窄或闭塞,其中轻度11例,中度18例,重度21例,闭塞9例;脑血管重度狭窄或闭塞灌注异常占比93.33％,高于脑血管无狭窄或轻中度狭窄的16.67％(P<0.05);颅内动脉、颈动脉狭窄程度与MTT、TTP呈正相关(P<0.05),与CBV、CBF无相关性(P>0.05).结论 320排容积CTP能同时获得常规CT扫描、全脑CTP、4D-CTA图像,全面显示脑缺血病灶、脑血流灌注参数及脑血管狭窄程度,为ICVD诊疗提供影像学依据.

目的 探讨超声造影(CEUS)对乳腺癌前哨淋巴结术前指导的价值.方法 选择80例经病理学确诊的乳腺癌患者,患者术前均行前哨淋巴结CEUS检测,记录造影特征与前哨淋巴结检出率,与病理结果进行比较.结果 80例患者经术前CEUS检查检出前哨淋巴结97枚,经术中蓝染法证实为前哨淋巴结,I型增强37枚、Ⅱ型增强55枚,Ⅲ型增强5枚,3例患者经术前CEUS未探及明确前哨淋巴结,术前CEUS前哨淋巴结定位率96.25％(77/80);CEUS诊断97枚前哨淋巴结中良性淋巴结37枚,转移性淋巴结60枚,CEUS检出阳性前哨淋巴结最大径大于阴性前哨淋巴结(P<0.05),存在周边声晕、血流Ⅱ～Ⅲ级枚数均多于阴性结果(P<0.05),病理检查诊断良性淋巴结61枚,阴性淋巴结26枚,CEUS诊断前哨淋巴结转移的灵敏度为100％,特异度为60.66％,准确率为75.26％,阳性预测值60.00％,阴性预测值100％.结论 CEUS在乳腺癌术前的前哨淋巴结定性评估具有良好效能,临床实用价值较高.

目的 分析3.0T磁共振(MRI)多b值弥散加权成像(DWI)与动态增强(DCE)扫描对前列腺癌术前诊断价值.方法 选取本院2017年4月至2019年11月收治的82例穿刺活检疑似前列腺癌的患者作为研究对象,分析DCE-MRI与DWI检查诊断前列腺癌的敏感性、特异性、准确性,比较前列腺癌与前列腺增生不同b值的ADC值.结果 以病理学活检为"金标准",DCE-MRI联合DWI检查诊断前列腺癌的敏感性、特异性、准确性分别为93.33％、89.19％、91.46％,其敏感性与病理学比较无差异(P>0.05);前列腺癌不同b值的ADC值均小于前列腺增生,两者比较差异显著(P<0.05).结论 3.0T MRI多b值DWI与DCE-MRI在诊断前列腺癌中具有一定的临床应用价值,术前可有效鉴别诊断前列腺良恶性疾病,具有较高的诊断准确性.

目的 研究小视野体素内不相干运动(intravoxel incoherent motion,IVIM)技术成像量化参数与前列腺癌(prostate cancer,PC)病理特征的关系及联合诊断价值.方法 选取PC患者62例作为观察组,良性前列腺增生症患者62例作为对照组.比较2组一般资料、IVIM技术成像量化参数[伪扩散系数(pseudo diffusion coefficient,D *)、灌注分数(perfusion fraction,f)、扩散系数(diffusion coefficient,D)、表观扩散系数(apparent diffusion coefficient,ADC)],应用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析 IVIM 技术成像量化参数及联合诊断PC的价值,并比较不同病理特征患者IVIM技术成像量化参数,采用Spearman及Pearson分析IVIM技术成像量化参数与病理特征的相关性.结果 观察组D、ADC低于对照组(P＜0.05);2组D*、f差异无统计学意义(P＞0.05).ROC分析结果显示,D、ADC诊断PC的AUC值分别为0.800、0.773;D、ADC联合诊断PC的AUC值为0.865,返回预测概率Logit(p)作为独立检验变量,结果显示,联合诊断的AUC值大于单一参数单独检测(P＜0.05).不同2016版肾癌WHO泌尿课程/国际泌尿病理协会分级、D'Amico危险度、肿瘤T分期、Gleason评分患者D、ADC差异有统计学意义(P＜0.05);不同肿瘤大小、PSA水平患者D、ADC差异无统计学意义(P＞0.05).D、ADC与ISUP分级、Gleason评分、D'Amico危险度、肿瘤T分期呈负相关(P＜0.05).结论 IVIM技术成像量化参数中D、ADC诊断PC敏感度、特异度较高且参数值与病理特征关系密切,二者联合不仅可进一步提高诊断效能,还能为临床评价病理特征提供参考,便于治疗方案的制定.

Objective The present study investigated the predictive value of each perfusion parameter of the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) in CT perfusion (CTP) imaging for the prognosis of endovascular treatment at the time of admission in patients with acute ischemic stroke in the anterior circulation. Patients and Methods The imaging data of 62 patients with acute ischemic stroke in the anterior circulation with an onset time of 6 h or less were retrospectively analyzed. All patients underwent the one-stop whole-brain dynamic volume four-dimensional (4D) CT angiography (CTA)-CTP and cranial magnetic resonance imaging (MRI) within seven days after treatment. The patients were divided into better and worse prognosis groups according to their clinical symptoms, combined with an MRI-ASPECTS score of ≤ 6 within seven days after treatment. The observed perfusion parameters included cerebral blood flow (CBF)-ASPECTS, cerebral blood volume (CBV)-ASPECTS, mean transit time (MTT)-ASPECTS, and time to peak (TTP)-ASPECTS. The difference in ASPECTS scores involving the CTP parameter, as well as diagnostic power, was compared between the two groups of patients. Results All CTP-ASPECTS scores negatively correlated with clinical prognosis. The higher the CTP-ASPECTS scores preceding treatment in patients with ischemic stroke in the anterior circulation, the better the prognosis. There were statistically significant differences in the scores of CBF-ASPECTS and CBV-ASPECTS between the two groups (P < 0.05). Receiver operating curve (ROC) analysis showed that the parameter with the largest area under the curve (AUC) was the CBF-ASPECTS score (P = 0.003), with a sensitivity of 90.9%, a specificity of 59.1%, and an AUC of 0.806, which was the most valuable prognostic predictor. Conclusion The CBF-ASPECTS score presented significant value as a primary indicator for predicting the outcome of endovascular treatment in patients with acute ischemic stroke in the anterior circulation, and it had good application prospects in clinical practice.

目的 探讨体素内不相干运动磁共振加权成像(IVIM-DWI)与动态增强磁共振(DCE-MRI)在前列腺疾病诊断中的联合应用价值.方法 前列腺疾病患者80例,术后病理诊断为前列腺癌34例(前列腺癌组,其中高分化4例、中分化12例、低分化18例)和良性前列腺增生46例(良性前列腺增生组),术前采用IVIM-DWI、DCE-MRI检查,测量IVIM-DWI参数真实的扩散系数(D)、伪扩散系数(D?)、灌注分数(f)以及DCE-MRI参数容量转移常数(Ktrans)、速率常数(Kep)、血管外细胞外间隙容积分数(Ve)、血管空间容积分数(Vp),另采用受试者工作特征曲线(ROC)分析IVIM-DWI联合DCE-MRI诊断前列腺疾病的价值.结果 与良性前列腺增生组比较,前列腺癌组D、f、Ve升高,D?、Ktrans、kep、Vp降低(P均<0.05).与低分化组比较,高分化者D?及中分化者D?、f、kep升高(P均<0.05);与中分化组比较,高分化者D?、kep升高,f降低(P均<0.05).IVIM-DWI联合DCE-MRI正确诊断前列腺癌33例、良性前列腺增生39例,诊断准确性为90.00％,AUC为0.909(95％CI为0.836～0.980),灵敏度为97.10％,特异度为84.80％.结论 IVIM-DWI联合DCE-MRI诊断前列腺疾病具有较高的灵敏度以及特异度,有助于初步评估前列腺疾病性质.

背景 肥厚型心肌病(HCM)是一种常见的遗传相关的心肌病,发病率高,准确测量室壁厚度是诊断HCM的关键,比较多种影像学检查方法诊断HCM的价值有助于提高HCM诊断正确率.目的 分析超声心动图(ECHO)、左心室心腔造影(LVO)对HCM的诊断价值.方法 回顾性分析2016年1月-2019年9月就诊于邯郸市中心医院的疑似HCM患者93例,均行ECHO、LVO和心脏磁共振(CMR)检查.以CMR检查结果为诊断HCM的"金标准",比较ECHO、LVO诊断HCM的正确率,并进一步比较ECHO、LVO、CMR三种检查方法对HCM患者左心16节段室壁厚度、左心室舒张末期容积(LVEDV)、左心室射血分数(LVEF)的测量值.随机抽取20例HCM患者,比较ECHO、LVO测量HCM患者左室壁16节段厚度、LVEDV、LVEF的组内相关系数(ICC).结果 CMR检查诊断HCM 78例,ECHO诊断HCM 68例,LVO诊断HCM 76例.ECHO诊断HCM的正确率为87.2％,低于LVO的97.8％(P<0.05).ECHO测量患者的左心室前壁中间段、心尖段,侧壁中间段、心尖段,下壁心尖段及室间隔厚度均大于LVO、CMR检查(P<0.05).ECHO对HCM患者LVEDV、LVEF的测量值低于CMR检查、LVO(P<0.05).应用LVO测量HCM患者左心16节段室壁厚度、LVEDV、LVEF的ICC均高于ECHO.结论 LVO对HCM的诊断价值优于ECHO,其可更精确地测量室壁厚度及左心室容积,提高HCM诊断准确性.

Objective Toinvestigatethevalueof3.0T MRreducedfield-of-view (rFOV)IVIM-DWIondistinguishingprostate cancerandprostatehypertrophy.Methods 30patientswithpathologicallyprovenprostatecancerand38patientswithprostatehypertrophy accordingtotheresultsofbiopsywereanalyzedretrospectively,whounderwent3.0T MRrFOV multipleb-valueDWIscanpreoperatively.The DWIscanwasperformedusing11b-valuesof0,30,50,100,150,200,400,800,1000,1500and2000s/mm2.ADC,slowdiffusion coefficient(D),fastdiffusioncoefficient(D?)andperfusionfraction(f)weremeasuredoncancerousfociandprostatehyperplasiafoci.Allofthe datawereanalyzed.Results TheADC,D,D?andfvaluesoftheprostatecancerwere(0.61±0.12)×10-3 mm2/s,(0.41±0.08)×10-3 mm2/s, (88.0±40.3)×10-3mm2/s,289.3%±29.4%,respectively,and(09.0±01.7)×10-3mm2/s,(05.4±01.3)×10-3mm2/s,(46.1±15.3)×10-3 mm2/s, 474.3%±10.85%,respectively,forprostatehypertrophy.Thedifferencesamongthefourparameterswerestatisticallysignificant(P<0.05).The areasofADC,D,D?andfvaluesunderROCcurvestodistinguishbetweenprostatecancerandprostatehypertrophywere09.32,08.27,01.58,0.976, respectively.Conclusion 3.0T MRrFOVIVIM-DWIcanreflectthetruewaterdiffusion motionandperfusionintheprostate,and maycontributetothedifferentialdiagnosisofprostatecancerandbenignprostatehyperplasia.